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Available online 4 March 2022
Functional angiography-derived index of microcirculatory resistance validated with microvascular obstruction in cardiac magnetic resonance after STEMI
Índice de resistencia microcirculatorio y obstrucción microvascular en la resonancia magnética cardiaca tras un IAMCEST
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Doosup Shina, Juwon Kimb, Ki Hong Choib, Neng Daic, YinLiang Lic, Seung Hun Leed, Hyun Sung Johb, Hyun Kuk Kime, Sung-Mok Kimf, Sang Jin Hag, Mi Ja Jangb, Taek Kyu Parkb, Jeong Hoon Yangb, Young Bin Songb, Joo-Yong Hahnb, Seung-Hyuk Choib, Yeon Hyeon Choef, Hyeon-Cheol Gwonb, Joo Myung Leeb,
Corresponding author
drone80@hanmail.net
joomyung.lee@samsung.com

Corresponding author: Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351 Seoul, Republic of Korea.
a Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
b Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
c Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
d Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
e Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
f Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
g Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Tables (4)
Table 1. Baseline characteristics of the study population
Table 2. CMR parameters according to angiography-derived IMR
Table 3. Echocardiographic parameters according to angiography-derived IMR
Table 4. Independent predictors for MVO determined by CMR
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Abstract
Introduction and objectives

The index of microcirculatory resistance (IMR) measured after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is associated with microvascular obstruction (MVO) and adverse clinical events. To evaluate MVO after successful primary PCI for STEMI without pressure wires or hyperemic agents, we investigated the feasibility and usefulness of functional angiography-derived IMR (angio-IMR).

Methods

The current study included a total of 285 STEMI patients who underwent primary PCI and cardiac magnetic resonance (CMR). Angio-IMR of the culprit vessel after successful primary PCI was calculated using commercial software. MVO, infarct size, and myocardial salvage index were assessed using CMR, which was obtained a median of 3.0 days [interquartile range, 3.0-5.0] after primary PCI.

Results

Among the total population, 154 patients (54.0%) showed elevated angio-IMR (> 40 U) in the culprit vessel. MVO was significantly more prevalent in patients with angio-IMR> 40 U than in those with angio-IMR ≤ 40 U (88.3% vs 32.1%, P <.001). Infarct size, extent of MVO, and area at risk were significantly larger in patients with angio-IMR> 40 U than in those with angio-IMR ≤ 40 U (P <.001 for all). Angio-IMR showed a significantly higher discriminatory ability for the presence of MVO than thrombolysis in myocardial infarction flow grade or myocardial blush grade (area under the curve: 0.821, 0.504, and 0.496, respectively, P <.001).

Conclusions

Angio-IMR was significantly associated with CMR-derived infarct size, extent of MVO, and area at risk. An elevated angio-IMR (> 40 U) after primary PCI for STEMI was highly predictive of the presence of MVO in CMR.

This trial was registered at ClnicalTrialsgov (Identifier: NCT04828681).

Keywords:
Index of microcirculatory resistance
Microvascular obstruction
Cardiac magnetic resonance imaging
ST-elevation myocardial infarction
Myocardial infarction
Abbreviations:
Angio-IMR
CMR
IMR
MVO
PCI
STEMI
Resumen
Introducción y objetivos

El índice de resistencia microcirculatoria (IRM) medido tras una angioplastia primaria (ICPp) por infarto agudo de miocardio con elevación del segmento ST (IAMCEST) se asocia con la aparición de obstrucción microvascular (OMV) y eventos clínicos adversos. Para evaluar la OMV tras una ICPp exitosa por IAMCEST sin guías de presión ni administración de agentes hiperémicos, variables que parecen limitar la adopción del IRM en el laboratorio de hemodinámica, se investiga la viabilidad y la utilidad de la medición del IRM mediante resonancia magnética cardiaca (RMC) (angio-IRM).

Métodos

El estudio incluyó a 285 pacientes con IAMCEST sometidos a ICPp y RMC. Con un programa informático comercial, se calculó el angio-IRM del vaso culpable tras la ICPp exitosa. Se evaluaron la OMV, el tamaño del infarto y el índice de rescate miocárdico medidos una mediana de 3 [rango intercuartílico, 3-5] días después de la ICPp.

Resultados

De la población total, 154 pacientes (54,0%) mostraron valores de angio-IRM elevados (> 40 U) en el vaso culpable. La OMV fue significativamente más frecuente en los pacientes con angio-IMR> 40 U que en aquellos con angio-IMR ≤ 40 U (el 88,3 frente al 32,1%; p <0,001). El tamaño del infarto, la extensión de la OMV y el área en riesgo fueron significativamente mayores en los pacientes con angio-IMR> 40 U que con angio-IMR ≤ 40 U (p <0,001 para todas las comparaciones). El angio-IRM mostró una capacidad de discriminación de OMV significativamente mayor que el grado de flujo TIMI o de blush miocárdico (área bajo la curva, 0,821, 0,504 y 0,496 respectivamente; p <0,001).

Conclusiones

El angio-IMR mediante RMC se asoció significativamente con el tamaño del infarto, la extensión de la OMV y el área en riesgo. Cifras altas del angio-IMR (> 40 U) tras una ICPp por IAMCEST fueron muy predictivas de OMV en la RMC.

Ensayo clínico registrado en ClnicalTrialsgov (Identifier: NCT04828681).

Palabras clave:
Índice de resistencia microcirculatoria
Obstrucción microvascular
Resonancia magnética cardiaca
Infarto agudo de miocardio con elevación del segmento ST
Infarto de miocardio

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